Providers Caring for an Aging Population Need Widespread HIE Use

HIE use enables the level of provider communication necessary to support complex and chronic disease management for aging baby boomers.

December 07, 2017 - Health information exchange (HIE) use allows providers caring for a highly-mobile aging patient population to send, receive, and access all types of health data to ensure quality care delivery. As the aging population grows, more and more data is necessary to manage progressing complex conditions.

HIEs and the networks that connect them – including Regional Health Information Organizations (RHIOs) and statewide HIE networks – can assist providers with communicating information for well-informed treatment.

The more patients and providers that participate in these HIE networks, the better. One HIE network, the Statewide Health Information Network for New York (SHIN-NY), is on a quest to achieve 100 percent hospital participation within the next three years.

Family medicine physician and member of the New York eHealth Collaborative (NYeC) Board of Directors Eugene Heslin, MD recently spoke to EHRIntelligence.com about the importance of SHIN-NY and HIE development to support patient care in a medical field flooded with data.

“Our ability to handle and manage information and knowledge is critical for the care of our patients,” said Heslin. “The HIE is the pipeline that connects all these different providers and organizations together.”

A firm believer in the importance of encouraging all hospitals across New York to participate in SHIN-NY, Heslin was recently recognized by NYeC for his commitment to advocating for the statewide HIE network.

Advocacy is one of the strategic mainstays of the SHIN-NY 2020 roadmap, which outlines the network’s plans to evolve in the coming years to support value-based care. Heslin said the aging baby boomer population presents a compelling use case for encouraging healthcare consumers to opt in to SHIN-NY.

A new way of caring for an aging population

Patients who are aged 65 and older will frequent healthcare facilities roughly 3 to 4 times more often than those under 65, Heslin said.

“You’re going to see patients accessing the healthcare system 12 to 15 times per year among the baby boomer population,” he clarified.

This high number of annual patient encounters presents an ideal opportunity to demonstrate how HIE use can allow for faster patient care delivery, cost savings, reductions in duplicate or redundant testing, and more accurate diagnoses and treatment.

Regardless of where these patient encounters occur, HIE use lets different providers at healthcare facilities across stateliness obtain patient information for efficient, cost-effective, and well-informed care delivery.

New York residents and providers have already seen the value of this kind of information sharing.

“In the Rochester area, providers were able to reduce significantly the amount of radiological tests necessary even in emergency departments because of their access to the radiology images,” said Heslin. “Not just the reports — the images.”

Heslin added that gaining the ability to exchange images was a pivotal revelation for healthcare providers in the area.

“Someone else’s image could be used by you,” he emphasized. “Go figure. It improved patient care because it allowed providers to do things more rapidly rather than waiting for a certain image to be shot, and it reduced the cost to the system.”

The aging baby boomer population has also served as an example for the importance of HIE use for complex and chronic disease management. The complex conditions common among the aging population necessitates well-informed disease management over an extended period of time.

“In order to be able to care for the baby boomers, we have to be able to deal with multi-dimensional disease state processes,” maintained Heslin. “We have to be able to take the information and push it up into somewhere, model it, build rule sets, and then change those rule sets back down at the end user or the physician’s office. Without the pipes—without the statewide HIE—that wouldn’t work.”

By opting in to participate in SHIN-NY, providers will be able to share medication histories, radiology images, and other patient information to improve safety among this at-risk population.

Furthermore – as the healthcare system transitions from a fee-for-service world to value-based care – healthcare organizations will need to utilize HIEs to spread information to all individuals who make up a patient’s care team.

“As we move from the volume world to the value world, we have to able to do things like transitions of care, and we need case managers to understand this,” Heslin said. “In team-based care, it’s about the whole team knowing the information.”

For example, admission, discharge, transfer (ADT) notifications are an integral part of team-based care. Enabling ADT notifications through an HIE allows hospital staff to communicate a patient’s movement and progress across the care continuum to improve care coordination.

“When a patient comes in to the hospital, we need to know with an ADT feed where they are,” he said. “Because that way we can help prepare for when they need to come out from the hospital.”

While encouraging HIE use is imperative to ensuring the benefits of exchange are felt throughout the industry, promoting rigorous HIE network governance is equally necessary. Laying down a set of standards and policies to instruct HIE participation enhances the efficacy, quality, and security of health data exchange.

HIE governance in an age of constant evolution

Researchers, providers, and other stakeholders agree on the importance of utilizing these pipelines to shuttle information between healthcare organizations in an increasingly mobile world. However, Heslin contended promoting thorough planning before the health data pipelines are built is just as important as advocating for their use.

“We have all the building blocks in place,” he said. “New York State has invested more than a billion and a half dollars in this. First, they made a governance model that wasn’t even an electronic pipe. It was about how to build the process.”

“If you don’t have governance and you don’t have process, you just have an electronic mess,” he continued. “New York has done this in a thoughtful, coordinated way.”

Ensuring an HIE is governed by a strict set of standards and policies can assist with normalizing health data, streamlining exchange, and safeguarding against security threats.

SHIN-NY is governed by a set of open and transparent processes that include input and expertise from key stakeholders. Stakeholders provide feedback on the development and implementation of HIE policies and technical standards.

For New York’s HIE network, HIE governance is an ongoing, revisionary process that continues long after the pipelines are in place.

NYeC and the New York State Department of Health (NYS DOH) convene several committees with stakeholders per year to continually update policy measures. While this level of standardization and governance helps to streamline exchange, EHR data is still not normalized to the extent that most providers and stakeholders hope to achieve.

“The data is not perfect,” Heslin said. “In every EHR, there’s variation with even just data about simple things like gender — male, female or other. Is that represented by a one, zero, or a two in the column? Is it an M or F or an O in the column? Then you have to depend on not just the pipes, but the way data is put into the system so you can normalize it to be able to use it across the care continuum.”

Variation in the way health data is represented causes problems with interoperability and points to the healthcare industry’s known weak area: lack of widespread health data standardization. Without consistently enforced health data standardization, HIE use cannot reach its full potential as a streamlined information delivery system across the care continuum.

Further normalizing data to streamline communication between EHR systems, provider organizations, and care settings is the next step in ensuring health IT infrastructure and health data are adequate to support value-based care.

In addition to continually strengthening its policies and technical standards, New York is also building its own all payer database (APD) to improve exchange. Unlike other APDs, New York’s database will contain more than just claims data.

“A lot of people build the APD, but we’re taking a different tack,” said Heslin. “We’re putting in not just claims data but also clinical data. When you match clinical data to claims data you get a more powerful tool.

Working to incorporate new kinds of data into its APD is one example of New York’s commitment to innovating for more efficient health data use.

“There’s a version of it that’s up and functioning internally to the state and in the beginning of next year there’s gonna be some external functionality as well,” revealed Heslin.

With new developments already in the works, Heslin and others involved with SHIN-NY hope to see HIE use continue to expand and improve to help bring the quality of care in New York to new heights.

“In the next couple years the network will hit critical mass,” said Heslin. “That’ll mean a majority of providers will be on board. We want 100 percent of our hospitals to participate in SHIN-NY by March.”

Continued advocacy by Heslin and other healthcare providers passionate about the benefits of HIE use will set SHIN-NY on track to achieve its goal.